Data from: Screening primary-care patients forgoing health care for economic reasons

Background: Growing social inequities have made it important for general practitioners to verify if patients can afford treatment and procedures. Incorporating social conditions into clinical decision-making allows general practitioners to address mismatches between patients’ health-care needs and financial resources. Objectives: Identify a screening question to, indirectly, rule out patients’ social risk of forgoing health care for economic reasons, and estimate prevalence of forgoing health care and the influence of physicians’ attitudes toward deprivation. Design: Multicenter cross-sectional survey. Participants: Forty-seven general practitioners working in the French–speaking part of Switzerland enrolled a random sample of patients attending their private practices. Main Measures: Patients who had forgone health care were defined as those reporting a household member (including themselves) having forgone treatment for economic reasons during the previous 12 months, through a self-administered questionnaire. Patients were also asked about education and income levels, self-perceived social position, and deprivation levels. Key Results: Overall, 2,026 patients were included in the analysis; 10.7% (CI95% 9.4-12.1) reported a member of their household to have forgone health care during the 12 previous months. The question “Did you have difficulties paying your household bills during the last 12 months” performed better in identifying patients at risk of forgoing health care than a combination of four objective measures of socio-economic status (gender, age, education level, and income) (R2=0.184 vs. 0.083). This question effectively ruled out that patients had forgone health care, with a negative predictive value of 96%. Furthermore, for physicians who felt powerless in the face of deprivation, we observed an increase in the odds of patients forgoing health care of 1.5 times. Conclusion: General practitioners should systematically evaluate the socio-economic status of their patients. Asking patients whether they experience any difficulties in paying their bills is an effective means of identifying patients who might forgo health care.

背景：
日益加剧的社会不平等（social inequities）使得全科医生（general practitioners）有必要确认患者是否能够负担治疗与各类诊疗操作。将社会状况纳入临床决策（clinical decision-making），能够帮助全科医生解决患者医疗需求与经济资源之间的错配问题。
研究目标：
旨在筛选出可间接排除患者因经济原因放弃医疗照护的社会风险的筛查问题，并估算放弃医疗照护的患病率，以及医师对社会剥夺（deprivation）的态度所产生的影响。
研究设计：
多中心横断面调查（multicenter cross-sectional survey）。
研究对象：
招募瑞士法语区的47名全科医生，使其纳入其私人诊所就诊患者的随机样本。
主要测量指标：
通过自填式问卷，将过去12个月内报告有家庭成员（包括本人）因经济原因放弃治疗的患者，定义为放弃医疗照护者。同时向患者询问了教育程度、收入水平、自我感知的社会地位以及社会剥夺程度相关问题。
主要结果：
总计纳入2026例患者进行分析；其中10.7%（95%置信区间9.4~12.1）报告其家庭成员在过去12个月内放弃了医疗照护。“您在过去12个月内是否存在支付家庭账单的困难”这一问题，在识别存在放弃医疗照护风险的患者方面，优于四种社会经济地位（socio-economic status）客观指标（性别、年龄、教育程度与收入）的组合（决定系数R²=0.184 vs 0.083）。该问题可有效排除患者存在放弃医疗照护的情况，其阴性预测值（negative predictive value）达96%。此外，对于那些面对社会剥夺感到无力的医师，其接诊患者放弃医疗照护的优势比升高1.5倍。
结论：
全科医生应当系统性评估患者的社会经济地位。询问患者是否存在支付账单的困难，是识别可能放弃医疗照护的患者的有效手段。